A new long-acting HIV antiretroviral drug could have a transformative effect on the global AIDS response, dramatically reducing new HIV infections, revolutionizing HIV treatment and saving many lives. Deborah Waterhouse, CEO of ViiV Healthcare Ltd (ViiV), developed and brought to market one of the first in this new class of drugs, long-acting injectable cabotegravir (CAB-LA). It is especially important for immediate use as an HIV prevention tool.
However, there is an urgent need to ensure equitable and affordable access to the new anti-HIV drug his company has developed so that it can be used globally to help reduce the inequalities that cause HIV pandemic. ViiV has shown its willingness to collaborate with the HIV community and recently declared its intention to negotiate a license with the Medicines Patent Pool and offer a lower price for certain key countries.
Despite the remarkable success of the global fight against AIDS, which has halved the number of HIV infections, progress is slowing dangerously. There are 1.5 million new infections a year and one person still dies every minute from AIDS. HIV infection has become rare in many communities, but others around the world face increasing risks of HIV.
HIV prevention drugs have disproportionately reached people in wealthy countries, while millions of people around the world who need them most have limited access. If CAB-LA is not widely available and affordable, it will deepen the inequalities that both fuel the AIDS pandemic and are exacerbated by it.
Access to vital science cannot and should not depend on passport possession or money in one’s pocket. New long-acting drugs could first reach those who need them most. Or they could roll out slowly, reach only a fraction of those who could benefit from them, and have a limited impact on the AIDS pandemic.
There is concern that long-acting injectable PrEP will not be affordable and available for years to come, including in the very countries and communities where studies have proven it works, unless action is taken quickly. But a good collaboration with ViiV can change that.
The 24th International AIDS Conference in Montreal, Canada, in July provides an historic opportunity for Ms Waterhouse to stand alongside world leaders, civil society and people living with and at risk of HIV around the world and to commit to actions that will save lives and accelerate efforts to end AIDS as a public health threat by 2030.
Additionally, on July 29, the World Health Organization will release new guidance on CAB-LA at the conference. These new technologies could be a lifeline for so many, including young women who fear stigma if seen taking HIV drugs, gay and transgender people facing repression and discrimination. homophobia, and sex workers who need better options. For the sake of equity, they must be affordable and accessible to all at the same time, in particular those in the Global South and the populations most exposed to risk.
As CEO of one of the world’s leading HIV pharmaceutical companies, Ms Waterhouse can help write a new future for millions of people living with HIV and at risk. After the first antiretroviral drugs for HIV were approved, prohibitive costs meant they were out of reach in countries in the Global South. Millions died. Eventually, generic competition and falling prices reversed this trend, saving an estimated 16.5 million lives. Today, nearly 10 million people living with HIV worldwide do not have access to life-saving treatment.
Each year, more than 680,000 preventable deaths are due to AIDS. As 2030, the United Nations target year to end AIDS as a public health threat, approaches, there is no time to waste in mobilizing new health technologies to achieve those whose needs have not yet been met by the global AIDS response and to give new choices to all those at risk.
Many actors have a role to play. National governments need to review this new drug and update their guidelines urgently. Health systems and communities must be supported to roll out new HIV prevention options as they become available. Capital investments in generic production facilities will be required. Community literacy efforts in treatment and prevention are needed to avoid misinformation. Donors need to mobilize funds to buy the drugs and fund the implementation science for effective delivery. All of this will depend on an affordable and sufficient supply.
Along with these actions requested by other stakeholders and using the platform of the International AIDS Conference, a team of global health practitioners, led by Quarraisha Abdool Karim, calls on Ms Waterhouse to:
- Advertise a lower price for the long-acting injectable ARV for prevention, CAB-LA, as close as possible to that of other HIV prevention drugs (PrEP). The current best PrEP option is around $60 per person per year. Make the price public and transparent, and include the cost of the accompanying syringe.
- Quickly finalize licenses to produce generic versions of this long-acting ARV through the Medicines Patent Pool. Licensed in low- and middle-income countries around the world on a non-exclusive basis, with a wide geographic scope for treatment and prevention.
- Sharing know-how and technology. Enable producers in Africa, Asia, Latin America, Eastern and Central Europe and beyond to seek transfer and start producing.
- Commit to making enough to meet demand until generic producers come online. ViiV can show the world that it can continue to accelerate progress in the fight against AIDS by ensuring that the best new prevention and treatment technologies can reach the millions of people who need them most, to stop the virus and prolong life with HIV.
Quarraisha Abdool Karim is Co-Founder and Associate Scientific Director of CAPRISA – Center for AIDS Research Program in South Africa, Professor of Clinical Epidemiology at Columbia University, New York; pro-vice-chancellor for health in Africa, University of KwaZulu-Natal, South Africa; and UNAIDS Special Ambassador for Adolescents and HIV.